Identifying the Missing Link in Viral Hepatitis Elimination Efforts

In this segment of Liver Lineup, Nancy Reau, MD, and Kimberly Brown, MD, revisit the ongoing challenge of meeting hepatitis B and C elimination targets, despite the availability of curative and highly effective therapies. Referencing recent observatory data compiled through collaborations between the World Health Organization and the US Centers for Disease Control and Prevention (CDC), the discussion underscores a persistent disconnect between what is possible scientifically and what is happening in real-world clinical practice.

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Reau frames the issue bluntly, asserting that viral hepatitis remains a set of diseases that can be cured or well controlled, yet health systems are still falling short of elimination goals. While Brown acknowledges that her institution still lags behind in certain aspects, she highlights a notable success with eliminating viral hepatitis within a closed dialysis population by implementing a strategy built on universal testing.

Of note, instead of relying on referrals or action from outside clinicians, patients were screened systematically, and those who tested positive were proactively contacted and treated. According to Brown, this model demonstrated that elimination is achievable when identification and treatment are tightly integrated, but it also revealed that relying on individual providers to initiate screening can be a major barrier.

Both experts agree that patient identification remains the central obstacle. Screening for hepatitis B and C often falls to primary care, while hepatologists are left to manage treatment once patients are referred. Reau notes that even in systems with robust screening programs in high-risk settings, such as emergency departments and urgent care centers, linkage to care can be difficult, particularly for patients who are not already established within the health system.

Reau also expresses frustration with referrals for abnormal liver enzymes that lack basic hepatitis B and C testing. While acknowledging that viral hepatitis is not the most common cause of abnormal liver chemistries, she emphasizes that standard screening remains widely recommended and should not be overlooked. The absence of this testing, she argues, reflects missed opportunities for diagnosis rather than thoughtful exclusion.

Brown echoes that screening has improved at her institution, noting that patients she sees with elevated liver enzymes are now routinely tested for hepatitis B and C, even when the ultimate diagnosis is MASLD. Together, the discussion highlights that meaningful progress toward hepatitis elimination will depend less on new therapies and more on systematic screening, proactive outreach, and closing persistent gaps in care delivery.

Editors’ note: Relevant Disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.

References

1. Manning J, Ward J, Hiebert-Suwondo L. Global Progress toward the Elimination of Hepatitis B: Country-Level Provisional Achievements of WHO Targets for Prevention, Care, and Reductions in Mortality. Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.

2. Ching Z, Hiebert-Suwondo L, Ward J. Global Progress Toward Hepatitis C Elimination: Monitoring Achievements of WHO Goals and Targets for Hepatitis C Prevention and Care. Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.